Physician Assistant Program SUPPLEMENTAL APPLICATION
deadline: AUGUST 1, 2015 (Must be postmarked on or before 8/1/2015)
Augsburg College PA Program
2211 Riverside Avenue
Campus Box 149
Minneapolis, MN 55454
APPLICATION INSTRUCTIONS
Thank you for your interest in applying to the Augsburg Physician Assistant (PA) Program.
The mission of Augsburg’s PA Program is to educate and develop its students in a manner consistent with the College’s overall mission, which is to nurture future leaders in service to the world. It does so by providing high quality educational opportunities based in the liberal arts and shaped by the faith and values of the Christian Church, by the context of a vital metropolitan setting, and by an intentionally diverse campus community. The PA Program will educate persons to be well-versed in current medical theory and practice which is dedicated to excellence in performance with the highest standards of ethics and integrity; to be committed to lifelong personal and professional development; to be respectful and sensitive to persons of all cultures and backgrounds; and to be oriented toward service to underserved communities.
The program accomplishes this by selecting and educating individuals who have academic and interpersonal attributes required in physician assistants and who are likely to practice in underserved communities in Minnesota, both rural and urban. The program’s curriculum educates these students by building the cognitive, clinical, interpersonal, and professional skills needed for the supervised practice of medicine as physician assistants in rural or urban underserved areas.
Students are selected through a competitive application process based on evaluation of the following factors: (l) academic preparation (including GPA, college course work, and proficiency in prerequisites); (2) professional potential (including motivation, maturity, and the ability to work with people; as well as knowledge of the physician assistant role and profession); (3) preparation for a health care career (health care and / or service related experience); (4) potential for practice in rural or urban underserved communities (demonstration of commitment and involvement with underserved communities as evidenced in personal essays). The CASPA and supplemental applications are reviewed by the admissions committee members.
The following supplemental application essay questions must be completed, printed, signed and received by the PA Program postmarked on or before August 1, 2015 for you to be considered for admission to the program. THE APPLICATION DEADLINE IS AUGUST 1, 2015. A non-refundable check in the amount of $50.00 made payable to the Augsburg College PA Program must accompany your supplemental application. Applications postmarked after August 1, 2015 will not be accepted.
Physician Assistant Program
GENERAL INFORMATION – aPPLICATION DEADLINe: AUGUST 1, 2015
Please complete the following. Use your arrow key or click in the field you wish to complete. Do not use the tab key.
Name: Social Security Number:
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Last First Middle
Other name(s) under which you may have records:
Preferred Mailing Address: Daytime Phone:
Evening Phone:
Cell Phone:
Email Address:
Residency/Education/Employment History
List each community in which you have lived within the last 15 years, from the most recent to the earliest. Also list the current population of that community, your primary occupation while living there, and the dates of your residence. If you were a student, please list “education” as your primary occupation and identify the school or institution attended.
Community of Residence / Population / County / State / Occupation / Month/YearFrom: / Month/Year
To:
Physician Assistant Program
SUPPLEMENTAL APPLICATION – PERSONAL NARRATIVES
Please complete the following essay questions as thoroughly and as concisely as possible. Please limit your response to 500 words or fewer for each essay question. Unsolicited documentation should not be submitted with your application (i.e. resumes, personal statements, etc.) When you have completed your essays, please print this document, sign, date, and return it to the PA Program office by August 1, 2015. Applications must be postmarked on or before August 1, 2015 to be considered.
1. Working as a physician assistant requires collaboration and teamwork. Describe the ways in which you would contribute to that team. Please give some specific examples of how you have contributed in a collaborative setting in the past.
2. Please describe how you interpret the notion of “underserved” and “at risk” populations and communities. Please provide specific examples of how you have worked with “underserved” and “at risk” populations.
3. Tell us about a time when you received performance feedback from your supervisor or criticism from a college professor that was unexpected. What was your response and what did you learn about yourselfin this situation?
4. Augsburg College’s physician assistant studies program is one of many programs nationally. What are some of the reasons you are applying to this program?
ACADEMIC/professional discIplinary action history
If you have been subject to academic/professional disciplinary action, explain below:
SIGNATURE (must be signed to qualify as a complete application)
PA students, by nature of their studies, are often in situations where they are dealing with vulnerable adult and juvenile populations. An applicant’s admission to the PA Program is contingent upon passing a background check.
My answers to the questions in this application are my original work, true, accurate and complete to the best of my knowledge. Any misrepresentation in these materials will be considered grounds for dismissal from the Augsburg College PA Program should I be accepted.
Signed: ______Date: ______